No / Enabling patients to be cared for in their preferred location often involves journeys between care settings. The challenge of ensuring journeys are timely and safe emerged as an important issue in an evaluation of palliative care services, which informed a service redesign programme in three areas of the United Kingdom by the Marie Curie Cancer Care 'Delivering Choice Programme'. This article explores perceptions of service users and key stakeholders of palliative care services about problems encountered in journeys between care settings during end-of-life care. This article draws on data from interviews with stakeholders (n = 44), patients (n = 16), carers (n = 19) and bereaved carers (n = 20); and focus groups (n = 9) with specialist nurses. Data were gathered in three areas of the United Kingdom. Data were analysed using a framework approach. Transport problems between care settings emerged as a key theme. Four particular problems were identified: (1) urgent need for transport due to patients' rapidly changing condition; (2) limited time to organise transfers; (3) the management of specialist equipment and (4) the need to clarify the resuscitation status of patients. Partnership working between Ambulance Services and secondary care is required to develop joint protocols of care to ensure timely and safe transportation between care settings of patients, who are near their end of life. Commissioning of services should be responsive to the complexities of patients' needs and those of their families.

Text in Afrikaans / Summaries in Afrikaans and English / Vigs is 'n "sluipende moordenaar "_ Dit toon geen respek vir kultuur, status,ouderdom of geslag nie. Vigs veroorsaak 'n onnnatuurlike dood wat vriende en familie bedreig en vervreem, lank na die dood van die vigsslagoffer. Die navorsingsdoel van hierdie studie was om riglyne daar te stel vir die psigoterapeutiese hantering van die vigslyer en sy gesin. Die navorsing het getoon dat 'n stigma en skuldgevoelens rondom die vigslyer en sy gesin ontstaan het, en dat hulle direk verantwoordelik gehou word vir die siekte bloot omdat hulle betrokke is by mekaar. 'n Vraelys wat aspekte (soos dit uit die literatuurstudie geblyk het) inkorporeer, is opgestel en aan die vigslyer en sy gesin gegee om te voltooi. Van die belangrikste elemente wat na vore gekom het, is die vrees vir die onbekende, die stigma verbonde aan die siekte en die pad wat die siekte loop ten opsigte van naiwiteit en valse gerugte ten opsigte van die siekte. 'n Verdere hoofstuk fokus op die literatuur om die hoofaspekte van die probleem vas le stel, en sodoende riglyne vir 'n terapieprogram daar te stel om die vrese te onderskep en die familie te help om die siekte beter te begryp_ Die doel is om die samelewing te laat begryp dat vigs nie 'n kulturele of "klas" siekte is nie, maar dat dit alle lae van die samelewing kan tref. 'n Afdeling is gewy aan 'n wye verskeidenheid terapeutiese tegnieke wat geimplimenteer kan word tydens hulpverlening aan die vigslyer en sy gesinslede. Verder verskaf hierdie studie ook riglyne om ondersteuning en hulp aan die vigslyer en sy gesin te bied, om sodoende hulle selfkonsep te verbeter. / Aids is a "stalking killer''. It has no respect for culture, breeding, age or sex. It is an unnatural death which offends and alienates many friends and family, even after the victim has died. A questionnaire incorporating important aspects of the cause and effect of aids was compiled and given to the aids sufferers and family to complete. From the responses it was clearly evident that the fears of the unknown, the stigma attached to the victim's close associates and family, was a problem, and the route course of incredible naive and false rumours. A chapter of the research focused on literature to establish what was the major aspects of the problem expressed by the media. Guidelines were provided whereby therapy could address and allay these fears to assist the family to better understand the illness and it's effects. This chapter has in mind to provide the Psychologist with guidelines to provide therapy to both the victim and the family in this regard. This study confirms that the survivors are the actual victims. / Educational studies / M.Ed. (Voorligting)

Text in Afrikaans / Summaries in Afrikaans and English / Vigs is 'n "sluipende moordenaar "_ Dit toon geen respek vir kultuur, status,ouderdom of geslag nie. Vigs veroorsaak 'n onnnatuurlike dood wat vriende en familie bedreig en vervreem, lank na die dood van die vigsslagoffer. Die navorsingsdoel van hierdie studie was om riglyne daar te stel vir die psigoterapeutiese hantering van die vigslyer en sy gesin. Die navorsing het getoon dat 'n stigma en skuldgevoelens rondom die vigslyer en sy gesin ontstaan het, en dat hulle direk verantwoordelik gehou word vir die siekte bloot omdat hulle betrokke is by mekaar. 'n Vraelys wat aspekte (soos dit uit die literatuurstudie geblyk het) inkorporeer, is opgestel en aan die vigslyer en sy gesin gegee om te voltooi. Van die belangrikste elemente wat na vore gekom het, is die vrees vir die onbekende, die stigma verbonde aan die siekte en die pad wat die siekte loop ten opsigte van naiwiteit en valse gerugte ten opsigte van die siekte. 'n Verdere hoofstuk fokus op die literatuur om die hoofaspekte van die probleem vas le stel, en sodoende riglyne vir 'n terapieprogram daar te stel om die vrese te onderskep en die familie te help om die siekte beter te begryp_ Die doel is om die samelewing te laat begryp dat vigs nie 'n kulturele of "klas" siekte is nie, maar dat dit alle lae van die samelewing kan tref. 'n Afdeling is gewy aan 'n wye verskeidenheid terapeutiese tegnieke wat geimplimenteer kan word tydens hulpverlening aan die vigslyer en sy gesinslede. Verder verskaf hierdie studie ook riglyne om ondersteuning en hulp aan die vigslyer en sy gesin te bied, om sodoende hulle selfkonsep te verbeter. / Aids is a "stalking killer''. It has no respect for culture, breeding, age or sex. It is an unnatural death which offends and alienates many friends and family, even after the victim has died. A questionnaire incorporating important aspects of the cause and effect of aids was compiled and given to the aids sufferers and family to complete. From the responses it was clearly evident that the fears of the unknown, the stigma attached to the victim's close associates and family, was a problem, and the route course of incredible naive and false rumours. A chapter of the research focused on literature to establish what was the major aspects of the problem expressed by the media. Guidelines were provided whereby therapy could address and allay these fears to assist the family to better understand the illness and it's effects. This chapter has in mind to provide the Psychologist with guidelines to provide therapy to both the victim and the family in this regard. This study confirms that the survivors are the actual victims. / Educational studies / M.Ed. (Voorligting)

SOCIAL WORK / MA(SS) (SOCIAL WORK)

Text in Afrikaans / The problem that motivated the study was that siblings of children with cancer may experience the relationships within the family differently after cancer treatment. The purpose was to investigate and describe how family dynamics are experienced by the siblings of a cancer patient after his/her treatment for cancer. The research methodology includes qualitative research of an explorative and descriptive nature. Data were collected through unstructured interviews with siblings of children who had received treatment for cancer. From this data eight categories were identified accordingly. Although the data do not indicate that siblings experienced family dynamics after treatment as problematic, as expected, the information contributes by making parents of cancer patients more aware of the siblings' emotions and needs. / Social Work / M.Diac (Spelterapie)

The hospice volunteer is viewed as an integral member of a multidisciplinary team, with various roles directed at enhancing the quality of life of patients and their families. The purpose of this study is to provide an integrated picture of the hospice volunteer, their role, the human dimensions of this role and the impact this has on their lives as not much has been written in literature about this specific sub-group of hospice workers. The context of the study is a hospice in Gauteng where the researcher works as a volunteer. The ethnographic case study has been chosen as an appropriate research design as it explores the above phenomenon from the volunteers' point of view. The subjects are three volunteers who have been active at the hospice for at least twelve months. Evidence in terms of specific interviews and observations are used to draw conclusions. The interviews are based on a minimal number of open-ended questions. The primary method of analysis is the examination of transcripts from these in-depth interviews. A thematic analysis is carried out in which a detailed description of the emerging themes are given. Four major themes are identified and explored: Description of the role; The experience of being a volunteer; A way of coping; and The influence of the hospice culture. Sub-themes that emerge within each case study vary due to the individual nature of the experience of the role. Themes are explored in light of current theory and findings. This was to note the similarities and differences of this specific sub-group of volunteers compared to others found in the literature reviewed for this study. As there is a scarcity of literature pertaining specifically to hospice volunteers, the study depends mostly on writings pertaining to hospice staff and volunteers in general. A summary and integration of the core findings of the three case studies is given and their similarities and differences are explored. How some of the different themes interlink is also discussed. Although various sub-themes found in the individual case studies are significant to the individual cases, some of them can be incorporated into common themes when looking at the volunteers as a group. The strengths and limitations of the study are discussed as well as recommendations for the hospice organisation and further research. / Psychology / M.A. (Psychology)

This study was undertaken as a qualitative needs assessment of emotional support to the adolescent with a terminally ill parent. Five participants in their adolescent life phase (14 to 18 years) with a terminally ill parent, participated in the study. Individual unstructured interviews were conducted with each participant, in order to assess their need for emotional support. With the consent of the parents and adolescents, the interviews were video-recorded and transcribed. Eight recurring themes were selected from the case studies and verified with the existing literature. The result of the study is the assessment of the need for emotional support to the adolescent with a terminally ill parent. / Social Work / M. Diac (Play Therapy)(Social Work)

This study examines through autoethnographic inquiry my research journey in the world of childhood cancer. The unfolding research experience eventually led to the focus of this investigation which is exploring stories of coping with childhood cancer in a support group for parents. Using the principles of ethnographic epistemology this study explores the stories of eight parents whose children were diagnosed with cancer and who decided to join the support group for parents called, TOUCH. An overview of the existing body of knowledge on childhood cancer and the family is presented as well as the value of a social support group in parenting a child with cancer. The need of a conceptual shift in order to understand the problem of parenting a child with cancer is propagated. The stories of eight parents within the setting of a social support group are presented. Through the principles of the qualitative method of ethnography the story of the child's cancer is described by means of emerging themes. The coping mechanisms used to cope in this world of uncertainty and ambiguity, follows. Finally the contribution of the support group is discussed in terms of my relationship with the group member, the group members' communication pattern and what was perceived to be helpful to the group member. The eight stories discussed all follow the same pattern. Four hypotheses emerged from the eight stories described and are presented in the final chapter. The strengths and limitations of the study are discussed as well as recommendations for future research. / Psychology / D. Lit. et Phil. (Psychology)

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.